Home Care as an Alternative to Psychiatric Hospital

A small proportion of patients with mental illness become too unwell for standard outpatient treatment with their psychiatrist or therapist. Their condition graduates to a higher level of severity and/ or an elevated risk of further deterioration. The treatment needs of patients under these circumstances involve four key requirements:

Optimise medication quickly through monitoring and review of mental state, prompt adjustments to regular medication, and administering further medication to relieve distressing symptoms as required.

The aim is to safely treat and manage patients in the least restrictive environment and still address the aforementioned needs. The choice of where treatment takes place - whether in hospital or in the community - will depend on, amongst other factors:

Patient preference;

Illness type and severity

Nature of potential risks

Rate at which illness is changing or responding to treatment

Household make-up (e.g. presence of relatives as carers or young children who may become upset by patient’s behaviour)

Past history

Financial circumstances and local resources

Experience of treating clinicians.

For example, patients with severe mental illness requiring treatment against their wishes will need to be in hospital, or if the risks of deterioration, harm to self or other people are serious; they may require summoning a greater number of staff at short notice, or undergo measures that restrict their wishes or enforce treatment. For most other acutely ill patients who retain their capacity to make decisions and are willing to engage in treatment, yet require more support than can be provided by their psychiatrist or therapist, home treatment would be suitable.

The NHS has acute psychiatric hospitals and patients requiring acute services can also access nurse-led Community Mental Health Teams, which have been helping patients overcome episodes of illness and preventing admissions to hospital for over 50 years in the UK. Yet, levels of severity for acceptance by NHS services are significantly higher than might expected, and waiting times often long due to resource limitations. In the private sector, hospital is often the only choice, even though it is not actually indicated or necessary, due to low awareness or promotion of community services beyond what psychiatrists can manage. This document sets out some of the similarities and differences between private hospital and private home treatment, both of which address the four key elements above:

IN HOSPITAL:

2-3weekly visits by a psychiatrist at set times

24/7nursing care

Group therapy sessions

Structure/Containment in a group environment

Removal from social and biological stressors

HOWEVER

Patients have little control over which professionals are involved in their care